The Ryan White Part B rate for 2025-2026 is based off of the 2025 Medicaid fee schedule rate x 30%, except where noted for medications/immunizations.
Service Code - 31.01 Office Visits
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 99201 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT (MD/DO). TYPICALLY, 10 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. |
N/A |
$56.02 |
|
| 99202 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT (MD/DO). TYPICALLY, 20 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. |
N/A |
$93.14 |
|
| 99203 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT (MD/DO). TYPICALLY, 30 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. |
N/A |
$135.22 |
|
| 99204 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT (MD/DO). TYPICALLY, 45 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. |
N/A |
$207.36 |
|
| 99205 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT (MD/DO). TYPICALLY, 60 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. |
N/A |
$260.61 |
|
| 99211 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT (MD/DO). TYPICALLY, 5 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. |
N/A |
$24.54 |
|
| 99212 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT (MD/DO). TYPICALLY, 10 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. |
N/A |
$53.87 |
|
| 99213 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT (MD/DO). TYPICALLY, 15 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. |
N/A |
$91.14 |
|
| 99214 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT (MD/DO). TYPICALLY, 25 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. |
N/A |
$134.50 |
|
| 99215 |
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT (MD/DO). TYPICALLY, 40 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES. |
N/A |
$181.67 |
|
| 99441 |
TELEHEALTH ORIGINATING SITE FEE |
$46.00 |
$59.80 |
|
| 99442 |
PHONE E/M BY PHYS 11-20 MIN |
$76.00 |
$98.80 |
|
| 99443 |
PHONE E/M BY PHYS 21-30 MIN |
$110.00 |
$143.00 |
|
| Q3014 |
TELEHEALTH ORIGINATING SITE FEE |
$29.96 |
$38.95 |
|
Service Code - 31.02 Venipuncture
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 36415 |
DRAWING BLOOD/SPECIMEN |
$2.25 |
$2.93 |
|
Service Code - 31.03 Panels
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 80047 |
METABOLIC PANEL, IONIZED CALCIUM |
$10.30 |
$13.39 |
|
| 80048 |
BASIC METABOLIC PANEL |
$6.35 |
$8.26 |
|
| 80050 |
GENERAL HEALTH SCREEN PANEL |
NC |
$45.12 |
|
| 80051 |
ELECTROLYTE PANEL |
$5.26 |
$6.84 |
|
| 80053 |
COMPREHENSIVE METABOLIC PANEL |
$7.92 |
$10.30 |
|
| 80055 |
OBSTETRIC PROFILE |
$35.86 |
$46.62 |
|
| 80061 |
LIPID PANEL |
$10.04 |
$13.05 |
|
| 80069 |
RENAL FUNCTION PANEL |
$6.51 |
$8.46 |
|
| 80074 |
ACUTE HEPATITIS PANEL |
$35.72 |
$46.44 |
|
| 80076 |
HEPATIC FUNCTION PANEL |
$6.13 |
$7.97 |
|
| 80081 |
OBSTETRIC PANEL |
$56.15 |
$73.00 |
|
Service Code - 31.04 Basic Labs
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 81596 |
HCV FIBROSURE |
$54.14 |
$70.38 |
New Code |
| 82040 |
ALBUMIN; SERUM |
$3.71 |
$4.82 |
|
| 82247 |
BILIRUBIN; TOTAL |
$3.77 |
$4.90 |
|
| 82248 |
BILIRUBIN; DIRECT |
$3.77 |
$4.90 |
|
| 82306 |
VITAMIN D, 25 HYDROXY |
$22.20 |
$28.86 |
|
| 82308 |
CALCITONIN |
$20.09 |
$26.12 |
|
| 82310 |
CALCIUM; TOTAL |
$3.87 |
$5.03 |
|
| 82340 |
CALCIUM URINE QUANT, TIMES SPEC |
$4.52 |
$5.88 |
|
| 82374 |
CARBON DIOXIDE (BICARBONATE) |
$3.66 |
$4.76 |
|
| 82390 |
CERULOPLASMIN |
$8.06 |
$10.48 |
|
| 82397 |
CHEMILUMINESCENT |
$10.59 |
$13.77 |
|
| 82435 |
CHLORIDES; BLOOD |
$3.45 |
$4.49 |
|
| 82465 |
CHOLESTEROL, SERUM, TOTAL |
$3.26 |
$4.24 |
|
| 82565 |
CREATININE KINASE (CK) (CPK);ISOFORMS |
$3.84 |
$4.99 |
|
| 82947 |
GLUCOSE; QUANTITATIVE |
$2.95 |
$3.84 |
|
| 83021 |
HEMOGLOBIN FRACTIONATION AND QUANTITATION |
$13.55 |
$17.62 |
|
| 83036 |
HEMOGLOBIN; GLYCATED |
$7.28 |
$9.46 |
|
| 83540 |
IRON |
$4.85 |
$6.31 |
|
| 83718 |
LIPOPROTEIN, DIR; HDL CHOLESTEROL |
$6.14 |
$7.98 |
|
| 84075 |
PHOSPHATASE; ALKALINE |
$3.89 |
$5.06 |
|
| 84132 |
POTASSIUM; SERUM |
$3.57 |
$4.64 |
|
| 84152 |
ASSAY OF PSA, COMPLEXED |
$13.79 |
$17.93 |
|
| 84153 |
PROSTATE SPECIFIC ANTIGEN(PSA) |
$13.79 |
$17.93 |
|
| 84154 |
PROSTATE SPECIFIC ANTIGEN (FREE) |
$13.79 |
$17.93 |
|
| 84155 |
PROTEIN TOTAL EXC REFRACT |
$2.75 |
$3.58 |
|
| 84156 |
ASSAY OF PROTEIN, URINE |
$2.75 |
$3.58 |
|
| 84157 |
ASSAY OF PROTEIN, OTHER |
$3.00 |
$3.90 |
|
| 84295 |
SODIUM; SERUM |
$3.61 |
$4.69 |
|
| 84300 |
SODIUM; URINE |
$3.80 |
$4.94 |
|
| 84403 |
TESTOSTERONE; TOTAL |
$19.36 |
$25.17 |
|
| 84439 |
THYROXINE; FREE |
$6.77 |
$8.80 |
|
| 84443 |
THYROID STIMULATING HORMONE (TSH) |
$12.60 |
$16.38 |
|
| 84450 |
TRANSAMINASE(SGOT);ASPARTATEAMINO (AST) |
$3.89 |
$5.06 |
|
| 84460 |
TRANSAMINASE(SGPT);ALANINEAMINO (ALT) |
$3.98 |
$5.17 |
|
| 84478 |
TRIGLYCERIDES |
$4.31 |
$5.60 |
|
| 84479 |
TRIIODOTHYRONINE(T-3),RESIN UPTAKE |
$4.85 |
$6.31 |
|
| 84480 |
TRIIODOTHYRONINE;TOTAL (TT3) |
$10.64 |
$13.83 |
|
| 84481 |
TRIIODOTHYRONINE,FREE, |
$12.71 |
$16.52 |
|
| 84482 |
TRIIODOTHYRONINE;REVERSE |
$11.82 |
$15.37 |
|
| 84520 |
UREA NITROGEN, (BUN) QUANTITATIVE |
$2.96 |
$3.85 |
|
| 85610 |
PROTHROMBIN TIME (PT) WITH INTERNATIONAL NORMALIZED RATIO (INR) |
$3.22 |
$4.19 |
New Code |
| 86328 |
IA NFCT AB SARSCOV2 COVID19 |
$45.23 |
$58.80 |
|
| 86355 |
B CELLS, TOTAL COUNT |
$28.30 |
$36.79 |
|
| 86356 |
MONONUCLEAR CELL ANTIGEN, QUANT., NOS |
$20.09 |
$26.12 |
|
| 86357 |
NK CELLS, TOTAL COUNT |
$28.03 |
$36.44 |
|
| 86590 |
STREPTOKINASE ANTIBODY |
$9.50 |
$12.35 |
|
| 86644 |
ANTIBODY; CYTOMEGALOVIRUS (CMV) |
$10.79 |
$14.03 |
|
| 86645 |
ANTIBODY; CYTOMEGALOVIRUS (CMV),IGM |
$12.64 |
$16.43 |
|
| 86735 |
ANTIBODY; MUMPS |
$9.79 |
$12.73 |
|
| 86762 |
ANTIBODY; RUBELLA |
$10.79 |
$14.03 |
|
| 86765 |
ANTIBODY; RUBEOLA |
$9.66 |
$12.56 |
|
| 86769 |
SARS-COV-2 COVID-19 ANTIBODY |
$42.13 |
$54.77 |
|
| 87271 |
CRYPTOSPORIDIUM/GARDIA AG, IF |
$10.07 |
$13.09 |
|
| 87272 |
CRYPTOSPORIDIUM ANTIGEN DETECTION BY DFA |
$8.99 |
$11.69 |
|
| 87332 |
CYTOMEGALOVIRUS ANTIGEN DETECTION BY EIA |
$8.99 |
$11.69 |
|
| 87495 |
CYTOMEGALOVIRUS DETECTION BY DNA, DIRECT PROBE |
$22.52 |
$29.28 |
|
| 87496 |
CYTOMEGALOVIRUS DETECTION BY DNA, AMP PROBE |
$26.32 |
$34.22 |
|
| 87497 |
CYTOMEGALOVIRUS DETECTION BY DNA, QUANTIF |
$32.13 |
$41.77 |
|
| 87635 |
SARS COVID - 19 AMP PRB |
$51.31 |
$66.70 |
|
| 87636 |
SARSCOV2 AND INF A AND B AND AMP PRB |
$142.63 |
$185.42 |
|
| 87637 |
SARSCOV2 AND INF A AND B AND RSV AMP PRB |
$142.63 |
$185.42 |
|
Service Code - 31.05 Platelets
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 85025 |
AUTO.CBC,PLT,AUTO COMPLT. DIFF |
$5.83 |
$7.58 |
|
| 85027 |
AUTOMATED CBC W/ PLATELET COUNT |
$4.85 |
$6.31 |
|
| 85032 |
MANUAL CELL COUNT, EACH |
$3.23 |
$4.20 |
|
| 85049 |
AUTOMATED PLATELET COUNT |
$3.36 |
$4.37 |
|
| 85055 |
RETICULATED PLATELET ASSAY |
$26.81 |
$34.85 |
|
| 85576 |
PLATELET, AGGREGATION (IN VITRO), EA AGENT |
$18.68 |
$24.28 |
|
| 85597 |
PLATELET NEUTRALIZATION |
$13.49 |
$17.54 |
|
| 86022 |
ANTIBODY IDENTIFICATION PLATELET ANTIBOD |
$13.78 |
$17.91 |
|
| 86023 |
ANTIBODY I.D. PLATELET ASSOC. IMMUNOGLOB |
$9.35 |
$12.16 |
|
Service Code - 31.06 T Cells
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 86359 |
T CELLS TOTAL COUNT |
$28.30 |
$36.79 |
|
| 86360 |
T CELL RATIO |
$35.24 |
$45.81 |
|
| 86361 |
T CELLS ABSOLUTE COUNT |
$20.09 |
$26.12 |
|
Service Code - 31.07 HIV
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 86689 |
HIV ANTIBODY; CONFIRMATORY |
$14.51 |
$18.86 |
|
| 86701 |
ANTIBODY; HIV-1 |
$6.67 |
$8.67 |
|
| 86702 |
ANTIBODY; HIV-2 |
$10.14 |
$13.18 |
|
| 86703 |
ANTIBODY; HIV-1 AND HIV-2; SINGLE RESULT |
$10.28 |
$13.36 |
|
| 87389 |
HIV-1 AG, HIV-1 AB, OR HIV-2 AB BY EIA |
$18.06 |
$23.48 |
|
| 87390 |
HIV-1 ANTIGEN DETECTION BY EIA |
$18.05 |
$23.47 |
|
| 87391 |
HIV-2 ANTIGEN DETECTION BY EIA |
$16.43 |
$21.36 |
|
| 87534 |
HIV-1 DETECTION BY DNA, DIRECT PROBE |
$16.44 |
$21.37 |
|
| 87535 |
HIV-1 DETECTION BY DNA, AMPLIFIED PROBE |
$26.32 |
$34.22 |
|
| 87536 |
HIV-1 DETECTION BY DNA, QUANTIFICATION |
$63.83 |
$82.98 |
|
| 87537 |
HIV-2 DETECTION BY DNA, DIRECT PROBE |
$16.44 |
$21.37 |
|
| 87538 |
HIV-2 DETECTION BY DNA, AMPLIFIED PROBE |
$26.32 |
$34.22 |
|
| 87539 |
HIV-2 DETECTION BY DNA, QUANTIFICATION |
$43.97 |
$57.16 |
|
| 87900 |
PHENOTYPE, INFECT AGENT DRUG |
$97.76 |
$127.09 |
|
| 87901 |
GENOTYPE, DNA, HIV REVERSE T |
$193.09 |
$251.02 |
|
| 87903 |
PHENOTYPE, DNA HIV W/CULTURE |
$366.50 |
$476.45 |
|
| 87904 |
PHENOTYPE, DNA HIV W/CLT ADD |
$19.55 |
$25.42 |
|
| 97905 |
INFECT AGENT ENZYM ACTIVITY O.T. VIRUS |
$9.17 |
$11.92 |
|
| 87906 |
NFCT GEXYP DNA/RNA HIV 1 OTHER REGION |
$96.55 |
$125.52 |
|
Service Code - 31.08 STI Screenings
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 86592 |
SYPHILIS TEST NON-TREP QUAL |
$3.20 |
$4.16 |
|
| 86593 |
SYPHILIS TEST NON-TREP QUANT |
$3.30 |
$4.29 |
|
| 86780 |
ANTIBODY; TREPONEMA PALLIDUM |
$9.93 |
$12.91 |
|
| 86631 |
ANTIBODY; CHLAMYDIA |
$8.87 |
$11.53 |
|
| 86632 |
ANTIBODY;CHLAMYDIA,IGM |
$9.51 |
$12.36 |
|
| 87110 |
CULTURE,CHLAMYDIA |
$14.70 |
$19.11 |
|
| 87270 |
CHLAMYDIA TRACHOMATIS ANTIGEN DETECTION BY DFA |
$8.99 |
$11.69 |
|
| 87320 |
CHLAMYDIA TRACHOMATIS ANTIGEN DETECTION BY EIA |
$11.25 |
$14.63 |
|
| 87490 |
CHLAMYDIA TRACHOMATIS DETECT BY DNA, DIR PROBE |
$17.06 |
$22.18 |
|
| 87491 |
CHLAMYDIA TRACHOMATIS DETECT BY DNA, AMP PROBE |
$26.32 |
$34.22 |
|
| 87528 |
HERPES SIMPLEX DETECTION BY DNA, DIRECT PROBE |
$15.04 |
$19.55 |
|
| 87529 |
HERPES SIMPLEX DETECTION BY DNA, AMP PROBE |
$26.32 |
$34.22 |
|
| 87530 |
HERPES SIMPLEX DETECTION BY DNA, QUANTIFICATION |
$32.13 |
$41.77 |
|
| 87531 |
HERPES VIRUS-6 DETECTION BY DNA, DIRECT PROBE |
$43.50 |
$56.55 |
|
| 87532 |
HERPES VIRUS-6 DETECTION BY DNA, AMP PROBE |
$26.32 |
$34.22 |
|
| 87533 |
HERPES VIRUS-6 DETECTION BY DNA, QUANTIFICATION |
$31.32 |
$40.72 |
|
| 87623 |
HPV LOW RISK TYPES |
$26.32 |
$34.22 |
|
| 87624 |
HPV HIGH RISK TYPES |
$26.32 |
$34.22 |
|
| 87625 |
HPV TYPES 16 & 18 ONLY |
$30.41 |
$39.53 |
|
| 87800 |
DETECT AGNT MULT, DNA, DIRECT (CHLAMYDIA & GC) |
$32.75 |
$42.58 |
|
| 87801 |
DETECT AGNT MULT, DNA, AMPLI |
$52.65 |
$68.45 |
|
| 87810 |
CHLAMYDIA TRACHOMATIS DETECT BY IMMUNOASSAY |
$26.47 |
$34.41 |
|
| 87590 |
N. GONORRHOEAE BY DNA, DIRECT PROBE |
$20.16 |
$26.21 |
|
| 87591 |
N. GONORRHOEAE BY DNA, AMPLIFIED PROBE |
$26.32 |
$34.22 |
|
| 87592 |
N. GONORRHOEAE BY DNA, QUANTIFICATION |
$32.13 |
$41.77 |
|
| 87850 |
N. GONORRHOEAE DETECTION BY IMMUNOASSAY |
$18.42 |
$23.95 |
|
| 87660 |
TRICHOMONAS VAGIN, DIR PROBE |
$15.04 |
$19.55 |
|
| 87661 |
TRICHOMONAS VAGINALIS AMPLIF |
$26.32 |
$34.22 |
|
| 87808 |
TRICHOMONAS ASSAY W/OPTIC |
$11.47 |
$14.91 |
|
Service Code - 31.09 Hepatitis
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 86708 |
HEPATITIS A ANTIBODY; TOTAL |
$9.29 |
$12.08 |
|
| 86709 |
HEPATITIS A ANTIBODY; IGM |
$8.45 |
$10.99 |
|
| 86704 |
HEPATITIS B CORE ANTIBODY; TOTAL |
$9.04 |
$11.75 |
|
| 86705 |
HEPATITIS B CORE ANTIBODY |
$8.83 |
$11.48 |
|
| 86706 |
HEPATITIS B SURFACE ANTIBODY |
$8.06 |
$10.48 |
|
| 86707 |
HEPATITIS B ANTIBODY |
$8.68 |
$11.28 |
|
| 87340 |
HEPATITIS B SURFACE ANTIBODY; DETECTION BY EIA |
$7.75 |
$10.08 |
|
| 87341 |
HEPATITIS B SURFACE, AG, EIA |
$7.75 |
$10.08 |
|
| 87350 |
HEPATITIS B ANTIGEN DETECTION, EIA CODE |
$8.65 |
$11.25 |
|
| 87380 |
HEPATITIS, DELTA AGENT ANTIGEN DETECTION, EIA |
$13.77 |
$17.90 |
|
| 86803 |
HEPATITIS C ANTIBODY |
$10.70 |
$13.91 |
|
| 86804 |
HEPATITIS C ANTIBODY; CONFIRMATORY TEST |
$11.62 |
$15.11 |
|
| 87517 |
HEPATITIS B DETECTION BY DNA, QUANTIFICATION |
$32.13 |
$41.77 |
|
| 87520 |
HEPATITIS C DETECTION BY RNA; DIRECT PROBE |
$23.42 |
$30.45 |
|
| 87521 |
HEPATITIS C DETECTION BY RNA; AMPLIFIED PROBE |
$26.32 |
$34.22 |
|
| 87522 |
HEPATITIS C DETECTION BY RNA; QUANT |
$32.13 |
$41.77 |
|
| 87798 |
INFECT AGT DETECT BY NUCLEIC ACID, NOS, AMP PROBE |
$26.32 |
$34.22 |
|
| 87902 |
HEPATITIS C GENOTYPE ANALYSIS |
$193.09 |
$251.02 |
|
| 86038 |
ANTINUCLEAR ANTIBODIES (ANA) |
$9.07 |
$11.79 |
|
Service Code - 31.10 TB
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 86480 |
TB TEST, CELL IMMUN MEASURE |
$46.49 |
$60.44 |
|
| 86481 |
TB ANTIGEN RESP GAMMA INTERFERON T-CELL SUSP |
$75.00 |
$97.50 |
|
| 86485 |
SKIN TEST; CANDIDA |
$9.00 |
$11.70 |
|
| 86486 |
SKIN TEST, ANTIGEN, NOS |
$3.49 |
$4.54 |
|
| 86490 |
SKIN TEST COCCIDIOIDOMYCOSIS |
$62.91 |
$81.78 |
|
| 86510 |
SKN TST.HISTOPLASMOSIS |
$4.48 |
$5.82 |
|
| 86580 |
SKIN TEST TUBERCULOSIS PATCH INTRADERMAL |
$5.72 |
$7.44 |
|
Service Code - 31.11 Cytopath
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 88104 |
CYTOPATH, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRETATION |
$52.16 |
$67.81 |
|
| 88106 |
CYTOPATH, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE FILTER METHOD WITH INTERPRETATION |
$46.09 |
$59.92 |
|
| 88108 |
CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION |
$43.75 |
$56.88 |
|
| 88112 |
CYTOPATH, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL |
$49.43 |
$64.26 |
|
| 88141 |
CYTOPATH, CERV/VAG INTERPRETATION |
$23.66 |
$30.76 |
|
| 88142 |
CYTOPATH, CERV/VAG THIN LAYER PREPARATION |
$15.20 |
$19.76 |
|
| 88143 |
CYTOPATH, CERV/VAG, THIN LAYER, REDO |
$17.28 |
$22.46 |
|
| 88147 |
CYTOPATH, CERV/VAG, AUTOMATED |
$37.92 |
$49.30 |
|
| 88148 |
CYTOPATH, CERV/VAG, AUTO RESCREENING |
$12.00 |
$15.60 |
|
| 88150 |
CYTOPATH, CERV/VAG(PAP)SCREEN INT <3 SMRS |
$11.94 |
$15.52 |
|
| 88152 |
CYTOPATH, CERV/VAG AUTOMATED |
$20.73 |
$26.95 |
|
| 88153 |
CYTOPATH, CERV/VAG, REDO |
$18.02 |
$23.43 |
|
| 88155 |
CYTOPATH, CERV/VAG HORMON EVALUATION |
$10.99 |
$14.29 |
|
| 88160 |
CYTOPATH, OTHER SOURCE SCREEN INTERPRET |
$54.02 |
$70.23 |
|
| 88161 |
CYTOPATH, ANY OTHER SOURCE; |
$47.33 |
$61.53 |
|
| 88162 |
CYTOPATH, OTHER, EXTENDED > 5 SLIDES' |
$69.68 |
$90.58 |
|
| 88164 |
CYTOPATH, TBS, CERV/VAG, MANUAL |
$11.94 |
$15.52 |
|
| 88165 |
CYTOPATH, TBS, CERV/VAG, REDO |
$31.67 |
$41.17 |
|
| 88166 |
CYTOPATH, TBS, CERV/VAG, AUTO REDO |
$11.94 |
$15.52 |
|
| 88167 |
CYTOPATH, TBS, CERV/VAG, SELECTION |
$11.94 |
$15.52 |
|
| 88172 |
EVALUATION ASP; IMMED CYTOHIST STUDY |
$42.04 |
$54.65 |
|
| 88173 |
EVALUATION ASP; CYTOHIST INTER AND RPT |
$111.55 |
$145.02 |
|
| 88174 |
CYTOPATH, C/V AUTO, IN FLUID |
$19.03 |
$24.74 |
|
| 88175 |
CYTOPATH C/V AUTO FLUID REDO |
$19.96 |
$25.95 |
|
| 88177 |
CYTP C/V AUTO THIN LYR PREPJ ADEQUACY EA EVAL |
$22.40 |
$29.12 |
|
Service Code - 31.12 Flowcytometry
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 88184 |
FLOWCYTOMETRY/ TC, 1 MARKER |
$46.85 |
$60.91 |
|
| 88185 |
FLOWCYTOMETRY/TC, ADD-ON |
$21.05 |
$27.37 |
|
| 88187 |
FLOWCYTOMETRY/READ, 2-8 |
$34.73 |
$45.15 |
|
| 88188 |
FLOWCYTOMETRY/READ, 9-15 |
$48.32 |
$62.82 |
|
| 88189 |
FLOWCYTOMETRY/READ, 16 & > |
$64.70 |
$84.11 |
|
Service Code - 31.13 Drug Screen
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 80150 |
AMIKACIN |
$11.31 |
$14.70 |
|
| 80178 |
LITHIUM |
$4.96 |
$6.45 |
|
| 80305 |
DRUG SCREEN; PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURE. THE CODES(80305,80306,80307) REPRESENT THREE DIFFERENT REPORTING METHOD CATEGORIES. |
$10.10 |
$13.13 |
|
| 80306 |
DRUG SCREEN; PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURE. THE CODES(80305,80306,80307) REPRESENT THREE DIFFERENT REPORTING METHOD CATEGORIES. |
$13.47 |
$17.51 |
|
| 80307 |
DRUG SCREEN; PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURE. THE CODES(80305,80306,80307) REPRESENT THREE DIFFERENT REPORTING METHOD CATEGORIES. |
$53.87 |
$70.03 |
|
Service Code - 31.14 Urinalysis
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 81000 |
URINALYSIS,REAGENT STRIPS WITH MICROSCOP |
$3.02 |
$3.93 |
|
| 81001 |
URINALYSIS, AUTO, W/SCOPE |
$2.38 |
$3.09 |
|
| 81002 |
URINALYSIS ROUTINE WO.MICROSCOPY,NONAUTO |
$2.61 |
$3.39 |
|
| 81003 |
URINALYSIS ROUTINE WO MICROSCOPY,AUTOMAT |
$1.69 |
$2.20 |
|
| 81005 |
URINALYSIS QUAL/SEMI NOT IMMUNOASSAY |
$1.63 |
$2.12 |
|
| 81007 |
URINALYSIS;BACTERIA SCREEN,NON-CULT,KIT |
$22.49 |
$29.24 |
|
| 81015 |
URINALYSIS MICROSCOPIC |
$2.29 |
$2.98 |
|
| 81020 |
URINALYSIS, GLASS TEST |
$3.53 |
$4.59 |
|
| 81025 |
URINE PREG TEST,VISUAL COLOR COMPARISON |
$6.46 |
$8.40 |
|
| 81050 |
VOLUME MEASUREMENT,TIME COLLECT,EACH |
$2.78 |
$3.61 |
|
| 82043 |
URINE,MICROALBUMIN,QUANT |
$4.34 |
$5.64 |
|
| 82044 |
URINE,MICROALBUMIN;SEMIQUANTITATIVE |
$4.67 |
$6.07 |
|
Service Code - 31.15 Cultures
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 87040 |
CULTURE, BACTERIAL, DEFINITIVE; BLOOD |
$7.74 |
$10.06 |
|
| 87045 |
CULTURE BACT DEFINITIVE AEROBIC STOOL |
$7.08 |
$9.20 |
|
| 87046 |
STOOL CULTR, BACTERIA, EACH |
$7.08 |
$9.20 |
|
| 87070 |
CULTURE BACT DEFIN AEROBIC OTHER SOURCE |
$6.47 |
$8.41 |
|
| 87071 |
CULTURE BACTERI AEROBIC OTHR |
$7.42 |
$9.65 |
|
| 87073 |
CULTURE BACTERIA ANAEROBIC |
$7.25 |
$9.43 |
|
| 87075 |
CULTURE BACTERIAL ANY SOURCE ANAEROBIC |
$7.10 |
$9.23 |
|
| 87076 |
CULTURE,BAC,AN;ID,EA ANAEROBIC ORGANISM |
$6.06 |
$7.88 |
|
| 87077 |
CULTURE AEROBIC IDENTIFY |
$6.06 |
$7.88 |
|
| 87081 |
CULTURE BACTERIAL SCREENING SINGLE ORGAN |
$4.97 |
$6.46 |
|
| 87084 |
CULTURE PRESUMPTIVE,KIT W COLONY ESTIM. |
$20.30 |
$26.39 |
|
| 87086 |
CULTURE BACT URINE QUANTIT COLONY COUNT |
$6.05 |
$7.87 |
|
| 87088 |
CULTURE BACT URINE IDENTIFICATION |
$6.07 |
$7.89 |
|
| 87101 |
CULTURE FUNGI ISOLATION SKIN |
$5.78 |
$7.51 |
|
| 87102 |
CULTURE,FUNGI,ISOLATION;OTHER SOURCE |
$6.31 |
$8.20 |
|
| 87103 |
CULTURE,FUNGI,ISOLATION;BLOOD |
$15.35 |
$19.96 |
|
| 87106 |
CULTURE,FUNGI,DEF.ID EA FUNGUS |
$7.74 |
$10.06 |
|
| 87107 |
FUNGI IDENTIFICATION, MOLD |
$7.74 |
$10.06 |
|
| 87109 |
MYCOPLASMA, ANY SOURCE |
$11.54 |
$15.00 |
|
| 87116 |
CULTURE TUBERCLE/ACID FAST BACIL ISOLATN |
$8.10 |
$10.53 |
|
| 87118 |
CULTURE TUB/ACID FAST BACIL DEFIN IDENTF |
$10.96 |
$14.25 |
|
Service Code - 31.16 Procedure
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 46220 |
EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS |
$131.85 |
$171.41 |
|
Service Code - 31.20 Immunizations
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 90471 |
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) |
$12.95 |
$16.84 |
|
| 90472 |
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); EACH ADDITIONAL VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) |
$9.85 |
$12.81 |
|
| 96365 |
IV INFUSION FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS; INITIAL, UP TO 1 HOUR |
$55.80 |
$72.54 |
|
| 96372 |
THER/PROPH/DIAG INJ, SC/IM |
$13.54 |
$17.60 |
|
| 96373 |
THER/PROPH/DIAG INJ, IA |
$14.18 |
$18.43 |
|
| 90620 |
MENINGOCOCCAL B, OMV |
$171.20 |
$222.56 |
|
| 90632 |
BCG A VACCINE ADULT IM |
$71.61 |
$93.09 |
|
| 90633 |
HEP A VACCINE PED/ADOL 2 DOSE |
$40.76 |
$52.99 |
|
| 90634 |
HEP A VACCINE PED/ADOL 3 DOSE |
$61.64 |
$80.13 |
|
| 90636 |
HEP A/HEP B VACCINE ADULT IM |
$97.37 |
$126.58 |
|
| 90651 |
HUMAN PAPILLOMAVIRUS VACCINE TYPES 6, 11, 16, 18, 31, 33, 45, 52, 58, NONAVALENT (9VHPV), 2 OR 3 DOSE SCHEDULE, FOR INTRAMUSCULAR USE |
$328.34 |
$426.84 |
|
| 90653 |
FLU VACCINE, INACTIVATED (IIV) |
$83.49 |
$108.54 |
|
| 90658 |
FLU VACCINE 3 YRS & > IM |
$21.86 |
$28.42 |
|
| 90662 |
FLU VACCINE IIV NO PRSV INCREASED AG IM |
$83.49 |
$108.54 |
|
| 90670 |
PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13), FOR IM |
$257.99 |
$335.39 |
|
| 90674 |
CCIIV4 VACCINE, NO PRSV, 0.5 ML IM |
$29.24 |
$38.01 |
|
| 90675 |
RABIES VACCINE IM |
$350.14 |
$455.18 |
|
| 90676 |
RABIES VACCINE ID |
$259.13 |
$336.87 |
|
| 90677 |
PCV20 VACCINE IM |
$298.04 |
$387.45 |
|
| 90682 |
RIV4 VACC RECOMB DNA IM |
$73.40 |
$95.42 |
|
| 90685 |
FLU VACCINE QUAD IM |
$21.64 |
$28.13 |
|
| 90686 |
FLU VACCINE QUAD IM |
$22.35 |
$29.06 |
|
| 90687 |
FLU VACCINE QUAD IM |
$10.44 |
$13.57 |
|
| 90688 |
FLU VACCINE QUAD IM |
$22.35 |
$29.06 |
|
| 90691 |
TYPHOID VACCINE IM |
NC |
$184.60 |
|
| 90698 |
DTAP-HIB-IP VACCINE IM |
$85.13 |
$110.67 |
|
| 90707 |
MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE |
$99.46 |
$129.30 |
MMR is live vaccine and should only be administered if CD4 >200. |
| 90713 |
POLIOVIRUS IPV SC/IM |
$89.64 |
$116.53 |
|
| 90714 |
TD VACC NO PRESV 7 YRS+ IM |
$27.94 |
$36.32 |
|
| 90715 |
TDAP VACCINE 7 YRS/> IM |
$35.64 |
$46.33 |
|
| 90716 |
CHICKEN POX VACCINE SC |
$160.74 |
$208.96 |
Chicken pox is a live vaccine and should only be administered if CD4 >200. |
| 90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
$133.47 |
$173.51 |
|
| 90733 |
MENINGOCOCCAL VACCINE SC |
$126.39 |
$164.31 |
|
| 90734 |
MENINGOCOCCAL VACCINE IM |
$115.88 |
$150.64 |
|
| 90735 |
ENCEPHALITIS VACCINE SC |
$102.08 |
$132.70 |
|
| 90739 |
HEPB VACC 2 DOSE ADULT IM |
$143.54 |
$186.60 |
|
| 90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
$130.25 |
$169.33 |
|
| 90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
N/A |
$26.90 |
|
| 90746 |
HEPB VACCINE 3 DOSE ADULT IM |
$65.12 |
$84.66 |
|
| 90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
$130.25 |
$169.33 |
|
| 90750 |
HZV VACC RECOMBINANT IM NJX |
$149.80 |
$194.74 |
|
| 90756 |
CCIIV4 VACC ABX FREE IM |
$28.37 |
$36.88 |
|
| J0561 |
INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS |
$26.82 |
$34.87 |
|
Service Code - 31.25 Radiology
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 71045 |
X-RAY EXAM CHEST 1 VIEW |
$14.98 |
$19.47 |
|
| 71046 |
X-RAY EXAM CHEST 2 VIEWS |
$22.86 |
$29.72 |
|
| 71047 |
X-RAY EXAM CHEST 3 VIEWS |
$29.20 |
$37.96 |
|
| 71048 |
X-RAY EXAM CHEST 4+ VIEWS |
$31.37 |
$40.78 |
|
| 76700 |
LIVER ULTRA SOUND-ECHO OF ABDOMEN |
$88.49 |
$115.04 |
New Code |
| 77078 |
CT BONE DENSITY, AXIAL |
$60.25 |
$78.33 |
|
| 77080 |
DXA BONE DENSITY, AXIAL |
$34.90 |
$45.37 |
|
| 77081 |
DXA BONE DENSITY/PERIPHERAL |
$23.90 |
$31.07 |
|
| 77085 |
DXA BONE DENSITY STUDY |
$40.18 |
$52.23 |
|
Service Code - 31.30 Vision
| HCPCS Code (CPT) |
Description |
Medicaid Rate |
Ryan White Rate |
U.S. Public Health Guidelines/Notes |
| 92002 |
EYE EXAM, NEW PATIENT |
$31.50 |
$40.95 |
Only allowable for services related to CMV. Pre-authorization required. |
| 92004 |
EYE EXAM, NEW PATIENT |
$56.57 |
$73.54 |
Only allowable for services related to CMV. Pre-authorization required. |
| 92012 |
EYE EXAM ESTABLISHED PT |
$39.48 |
$51.32 |
Only allowable for services related to CMV. Pre-authorization required. |
| 92014 |
EYE EXAM & TREATMENT |
$57.78 |
$75.11 |
Only allowable for services related to CMV. Pre-authorization required. |
